Kyle Hoedebecke

Health care and social media: What patients really understand

Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

Young Doctor Movements: motives for membership among aspiring and young family physicians.

Background: Over the past decade, young doctor movements (YDMs) have gained recognition for their efforts in promoting the discipline of family medicine. With growth and expansion comes the need for an inquiry into the membership motives of current/intending members. Aim and Objectives: This study was aimed at determining the main reasons why young and aspiring family physicians (FPs) joined their regional YDM. It was also concerned with determining the main factors that will make non-members want to join a YDM as well as assessing for differences in the responses within YDM members on the one hand, and between YDM members and non-members on the other. Materials and Methods: This was a cross-sectional web-based study. Using a list of 11 items generated following a series of discussions and feedback among selected FPs and FP trainees, respondents annotated levels of agreement on reasons for current or desired YDM membership. The Mann–Whitney U test was used to determine the distribution and differences in the mean of rank scores of the responses from YDM and non-YDM members while the Kruskal–Wallis test was used to describe same for the various YDMs. Results: The total number of respondents was 200, out of which 102 (51.0%) were current YDM members, 97 (48.5%) were non-members and 1 (0.5%) respondent did not state his/her membership status. Non-YDM members indicated a predominantly academic/professional motive for membership while YDM members indicated the opportunity to socialise with FPs abroad and in their country as their foremost reasons for membership. A mixture of academic, professional and social motives was observed for respondents from Vasco da Gama; predominantly academic and professional motives for respondents from Spice route. Conclusions: While gaining recognition and improving ones practice may be the ultimate goal of an aspiring FP, socialising within a network of like-minded professionals maybe the young FPs way of coping with demands of the discipline.

Non-HDL cholesterol is better than LDL-c at predicting atherosclerotic cardiovascular disease risk factors clustering, even in subjects with near-to-normal triglycerides: A report from a Venezuelan population

Non-high density lipoprotein cholesterol (non-HDL-c) has Background: emerged as an important tool in primary prevention of atherosclerotic cardiovascular disease (ASCVD), especially among those at high risk. The main objective of this study was to evaluate the predictive value of non-HDL-c for the coexistence aggregation of multiple ASCVD risk factors and compare this with LDL-c in general subjects with normal or near normal triglycerides from Maracaibo city in Venezuela. This is a descriptive, cross-sectional study with a randomized Methods: multistage sampling. 2026 subjects were selected for this study, all were adults ≥18 years old of both genders and inhabitants of Maracaibo city, Venezuela. A complete history and physical medical assessment was performed. A multivariate logistic regression model was used to determine the odds ratio (CI95%) for the coexistence of multiple risk factors for ASCVD. The median (p25-p75) of non-HDL-c was 143 mg/dL (114-174 Results: mg/dL). 52.1% (n=1056) of the sample were women, with a median of 144 mg/dL (115-174 mg/dL) among women and 143 mg/dL (114-17 4mg/dL) among men; p=0.740. Individuals ≥50 years old, smokers, those with 1,2 2 2 2 3 2 2 2 2 2 3 4 5,6 1 1 1 1

A qualitative study of young Nigerian family physicians’ views of their specialty

Background: In Nigeria, the specialty of family medicine (FM) has endured its own share of identity crises. This study was aimed at generating hypotheses about what describes a practising family physician (FP) and the specialty, according to young Nigerian FPs. Methods: Using the online platform for young African FPs alongside text messages and emails from volunteer research assistants over an eight-week period (March 3 to April 30, 2015), a purposive sample of young Nigerian FPs were asked to describe their favourite aspect of FM in a single word/phrase. Responses were provided in English/individual’s mother tongue. Translation of the words was performed by respondents and additional collaborators fluent in these languages. Thematic analysis using the grounded theory approach was performed. Results: Twenty-four responses were received consisting of four themes: Scope, Family, Skills/Feelings/Values, and Professional Fulfilment. The resulting data portrayed the FP as one who possesses a unique skill-set, enjoys fulfilment in the profession, deals with undifferentiated diseases and is able to provide holistic care for patients (irrespective of age and gender) from a family-centred perspective. When compared with accepted domains of FM for Africa and Europe, roles of the FP in community-oriented care and primary care management were absent. Conclusion: While this showcases the young Nigerian FPs’ acceptance of their role in providing comprehensive primary care, it suggests a lesser acceptance of their role in community-oriented primary care as well as primary care management. This study provides a basis for future, quantitative research describing attitudes and competence in these areas.

Case Report: An incidentaloma that catches your eye - adrenal myelolipoma

Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma. An MRI was performed revealing a 7x6cm lesion in the right adrenal area indicating a giant adrenal adenoma. An adrenalectomy was performed without complications. The pathology report identified a myelolipoma. Discussion: The incidence of myelolipoma has recently increased due to advances in radiological techniques. Its etiology is unclear and the most accepted theories support a myeloid cell metaplasia in the embryonic stage as a result of stress, infections, or adrenocorticotropic hormone or erythropoietin stimulus. Contributing components may include bone morphogenetic protein 2 and β-catenin, as well as the presence of the chromosomal translocation (3, 21) (q25; p11). Despite its benign nature, the association with other adrenal lipomas must be ruled out. A biochemical evaluation is essential for detecting subclinical states, such as Cushing syndrome and pheochromocytoma. Conclusion: Adrenal myelolipomas are rare benign tumors that are generally asymptomatic. Uncertainty still exists surrounding their etiology. Surgical management depends on hormone production, tumor size, high risk features on imaging and patient consent. Additional information is needed to better understand myelolipomas, their etiology, and clinical management. Incidentalomas may confuse the physician and patient. Ensuring proper multidisciplinary management based on the clinical guidelines of endocrinology allowed a satisfactory resolution of this case.

Corticosteroids in sports-related injuries: Friend or Foe

The international #1WordforFamilyMedicine initiative serves to explore the identity of family physicians and allows the international Family Medicine community to collaborate on advocating the discipline. South African family physicians provided 42 responses via a social media and online survey. Two “word cloud” images were created based on two icons recognised as being truly South African around the world – that of the national flag and former president Nelson Mandela. The #1WorldforFamilyMedicine initiative was promoted by the World Organization of Family Doctors across the globe to help celebrate World Family Doctor Day on 19 May 2015. To date, over 70 images have been created in 50 different countries on six continents. The images represent family physicians’ love for their profession and the community they serve. It is hoped that this initiative will help to inspire current and future Family Medicine and primary care providers.